Issue link: http://viewer.e-digitaledition.com/i/872903
Hector thought a few hours of sleep might help him feel better, but that was not the case. When he took his temperature, he had a fever of 102 degrees. It was time to seek help. He preferred to see his regular doctor, who knew his history with diabetes, but he could not get an appointment until the next day. Hector decided to go to the ED instead. Was it the right decision? "It is always a good idea for people with chronic conditions, such as diabetes and high blood pressure, to see their primary care doctor when they get sick because he or she knows best how treatment for a short-term illness may affect the management of a long-term disease," says Anna Donnelly, R.N., nurse manager of emergency services at NYP Brooklyn Methodist. "But, if they can't get a quick appointment with their doctor or symptoms are severe, the ED is the right place for these patients." SCENARIO THREE: A VEIN THING Sarah, a 72-year-old retiree, has varicose veins. When she last visited her doctor, he told her that the condition placed her at risk for developing venous ulcers—sores on the legs that occur when blood is obstructed from returning to the heart through the veins, causing it to pool in the vessels. Two months ago, Sarah's right leg began to ache. One morning, while examining the leg before getting in the shower, she noticed a dark, irregularly shaped bruise. She worried that a venous ulcer was forming. She thought about going to the ED, but after further consideration, she called her doctor's office, scheduled an appointment for the next day, and spoke with a nurse about how to care for her leg at home until she saw the doctor. Was it the right thing to do? Sarah's doctor knew her medical history best, and because her wound was not severe or life threatening—it showed no signs of infection like redness or swelling—she could safely wait to receive treatment at her doctor's office. SCENARIO FOUR: DINNER, INTERRUPTED Six months ago, Ethan, a 38-year-old office worker, experienced something he never expected. He was out to dinner with his wife, Bonnie, and two young daughters, when intense pain struck the right side of his abdomen just before his meal arrived. He slumped forward and almost fell out of his chair. Immediately, he thought it might be appendicitis. Bonnie called her sister, Ellen, who lived nearby to come to the restaurant and pick up the children. When Ellen arrived, Bonnie took Ethan to the nearest ED. Did they make the right choice for his symptoms? "Abdominal pain, especially if it's never occurred before, certainly warrants assessment in the ED," Dr. Vaccari says. "If it turns out to be appendicitis, it could be life-threatening. Symptoms that could indicate a heart attack or stroke like chest pain, light-headedness, facial drooping and one-sided weakness also need emergency care." In the ED, the medical team uses a process called differential diagnosis to discover the cause of symptoms that could be attributed to multiple diseases. "Abdominal or chest pain are cues to get to the nearest ED quickly," Ms. Donnelly says. "We have equipment, such as electrocardiograms and computed tomography scanners, that can rule out potential causes one by one." ED staff members have the skills and equipment to treat time-sensitive, life- threatening conditions like appendicitis, heart attack or stroke and reverse or minimize their effects. D E M Y S T I F Y I N G T H E " S Y S T E M O F T R I A G E " Emergency departments do not operate according to a first-come, first-served model, and that is by design. "When people wait in line at a bank or to get through security at an airport, it's unacceptable to cut in front of them," Dr. Melniker says. "But that happens all the time in the ED because of triage—a system that ensures that patients with the most serious conditions are seen first. Understanding the triage process can greatly reduce patient stress in the ED." Patients who arrive in the ED (or their companions if the patients cannot talk) describe their condition to a nurse, who categorizes the patient on a one-to-five scale based on the severity of illness or injury. Patients in levels one and two are assessed first for life-threatening issues like an inability to breathe or when a heart attack or stroke is suspected. Level-three patients with conditions that are urgent but not life threatening are seen next. Levels four and five may be directed to a different section of the ED for treatment. "Multiple programs exist here in the ED, including fast track services like our S.M.A.R.T. and Rapid Evaluation Programs" Dr. Melniker says. "The S.M.A.R.T. program, which stands for Simple Medical screening And Rapid Treatment, means that patients' receive medical screenings by a registered nurse or physician's assistant after signing in. This process allows doctors and nurses to assess the severity of patients' emergencies, so treatments can begin sooner. The Rapid Evaluation Unit is only for minor emergencies like ankle sprains or other minor injuries, upper respiratory infections and more emergent symptoms like a cough with a fever, which can indicate pneumonia." FA L L 2 017/ / W W W.N Y P.O RG / BRO OKLY N 18 S P E C I A L R E P O R T